股神经联合坐骨神经阻滞在全膝关节置换多模式镇痛中的应用

发布时间：2018-08-01 10:05

【摘要】：背景:股神经阻滞在全膝关节置换术围手术期镇痛中的有效性得到广泛认可,但对于联合坐骨神经阻滞的必要性一直存在争议。目的:探讨股神经联合坐骨神经阻滞在全膝关节置换围手术期多模式镇痛中的镇痛效果及对功能锻炼的影响。方法:将150例拟行全膝关节置换的患者随机分为3组,每组50例。全麻组术前行常规全麻;股神经阻滞组在全麻前行术侧股神经阻滞;股神经+坐骨神经阻滞组在全麻前分别行术侧股神经、坐骨神经阻滞。比较3组患者术后静息、运动状态下的目测类比评分,膝关节主动活动度,术后住院天数,不良反应及复诊时的膝关节HSS评分。结果与结论:(1)股神经阻滞组、股神经+坐骨神经阻滞组术后各时间点静息、运动目测类比评分均显著低于全麻组(P0.05),股神经+坐骨神经阻滞组显著低于股神经阻滞组(P0.05);(2)股神经阻滞组、股神经+坐骨神经阻滞组术后各时间点膝关节主动活动度均显著大于全麻组(P0.05),股神经+坐骨神经阻滞组显著大于股神经阻滞组(P0.05);(3)股神经阻滞组、股神经+坐骨神经阻滞组术后住院天数均显著少于全麻组(P0.05),股神经+坐骨神经阻滞组显著少于股神经阻滞组(P0.05);(4)术后1个月时,股神经阻滞组、股神经+坐骨神经阻滞组的膝关节HSS评分均显著高于全麻组(P0.05),股神经+坐骨神经阻滞组显著高于股神经阻滞组(P0.05);术后3个月和6个月时,3组间的膝关节HSS评分差异无显著性意义(P0.05);(5)结果提示,与全麻及股神经阻滞相比,股神经联合坐骨神经阻滞在全膝置换围手术期多模式镇痛中有更好的术后镇痛效果,为全膝关节置换患者术后早期功能锻炼提供了有利条件。
[Abstract]:Background: the effectiveness of femoral nerve block in the perioperative analgesia of total knee arthroplasty is widely recognized, but the necessity of combined sciatic nerve block has been controversial. Objective: To explore the analgesic effect and functional exercise of femoral nerve block combined with sciatic nerve block in the perioperative multimode analgesia. Methods: 150 patients with total knee arthroplasty were randomly divided into 3 groups, 50 cases in each group. The general anesthesia group was performed general anesthesia before the operation; femoral nerve block group was performed the femoral nerve block before general anesthesia; femoral nerve + sciatic nerve block group was treated with the lateral femoral nerve and the sciatic deity block before general anesthesia. The 3 groups were resting after the operation, and the movement state was compared. Results and conclusions: (1) the femoral nerve block group, the femoral nerve and the sciatic nerve block group were resting at all time points after the operation, and the exercise visual analogue score was significantly lower than the general anesthesia group (P0.05), the femoral nerve + sciatic nerve block group was significant (1) Lower than the femoral nerve block group (P0.05); (2) the femoral nerve block group, the femoral nerve + sciatic nerve block group was significantly greater than the general anesthesia group (P0.05), femoral nerve + sciatic nerve block group was significantly greater than the femoral nerve block group (P0.05); (3) femoral nerve block group, femoral nerve + sciatic nerve block group after operation days after operation Significantly less than the general anesthesia group (P0.05), femoral nerve + sciatic nerve block group was significantly less than the femoral nerve block group (P0.05); (4) 1 months after the operation, the femoral nerve block group, the femoral nerve + sciatic nerve block group HSS score was significantly higher than the general anesthesia group (P0.05), femoral nerve + sciatic nerve block group was significantly higher than the femoral nerve block group (P0.05); after the operation, the group was significantly higher than the femoral nerve block group (P0.05). There was no significant difference in HSS score between the 3 groups at 3 months and 6 months (P0.05). (5) the results suggested that the femoral nerve combined with sciatic nerve block had better postoperative analgesic effect in the multimodal analgesia during total knee replacement, and provided the early functional exercise for the patients with total knee replacement. Favorable conditions.
【作者单位】：安徽医科大学第一附属医院关节与骨肿瘤外科;安徽医科大学第一附属医院麻醉科;
【分类号】：R614

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